at what point do you start "investigating"?

[daurelia]

Hey all.

I am wondering at what point do I start investigating into potentially having fertility problems.

I've been trying for a year. My circumstances are unusual in that a year ago, I got pregnant the first cycle I tried, miscarried, and have been unable to get pregnant since. When I first miscarried I comforted myself by saying "I got pregnant so easily, surely it won't be hard to get pregnant again". But here I am, one whole year later. We did take a couple months off in the middle for career reasons, but otherwise, we've been trying with lots of sex around ovulation and no luck. Everyone I know who was trying along with me (a lot of women) has gotten pregnant just fine.

I'm also unsure what the problem is. We just got my husband tested and his SA was far above average on all counts.  I practiced fertility awareness birth control for YEARS before trying so I already know that I ovulate and have EWCM and a temp shift and a textbook cycle. I am only 30 years old. I am a healthy weight and lead a very healthy life. I read fertility books and I'm like "so what? I do all those things." I've completely cut out booze and caffeine. So I'm really confused about what the problem is.

I know many of you here are "veterans" who might understandably roll their eyes at me coming here. My gyno waved away my concerns. But I guess I'm wondering, when should I start to take this issue seriously? After how many cycles? What should I do first? Should I see a RE or continue to work with my gyno (who said she'd do the day 3 test for me as well as that dye-the-fallopian-tubes one, I forget the name).

Any thoughts or advice for someone who is potentially staring down the road of infertility would be helpful.

[AdinaL]

If it has been a year then most doctors will see you at this point and start looking for causes.  So, yeah, take your doc up on her offer, see what the tests show.  Then if you find something that warrants it you can move to an RE.  I advise going this route because often REs aren't covered, so if you can start with your regular doctor, that might be less expensive in the long run.

Otherwise, it sounds like you are doing everything right. 

[daurelia]

Thank you, Adina.

I guess "technically" I've been trying for 9 months if you subtract the 3 cycles we stopped (I started a new job).  But I feel like that's long enough to know something is up when I am so knowledgeable and am doing all the right things!

I also have all these irrational, non-scientific worries that I wish I could share with a doctor without them waving me away. Like, what if my miscarriage caused some sort of infection? I know, it sounds kind of nutty, but I'm just so confused about why this is happening, that it's causing me to obsessively try and figure out what is wrong with me. I've always been a really healthy person and my fertility signs are crystal clear, I don't understand what could be wrong.

Once I get those day 3 tests I suppose I'll have more information.... can't get it this cycle since I'll be out of town when I get my period next. I guess that's going to force me to try and relax about this this summer... easier said than done, which I know all of you can attest to. 

Thanks for listening. This whole experience has been one of the hardest things I've ever gone through, and I feel like no one I know can understand these terrible feelings I am having.

[AdinaL]

You know, it is an absolute bear trying to figure out what is going on.  Trust your instincts - if something feels off, then get it checked out.  :)  

[monkeyscience]

Yeah, I second what Adina said. Also, it's very possible that something is up with your uterus/tubes, which wouldn't show up in your charting at all, and could have contributed to your miscarriage. So doing an HSG (the dye-in-tubes thing) could be useful. A saline sonohystogram (I think that's what it's called), could also be useful in determining any uterine abnormalities, or finding fibroids or polyps. (Not sure if those show up on an HSG, but they might.)

Another thing to consider as far as timing - the rule of thumb is that 1 year of trying without success = infertility, but I don't think that rule was based on women charting and knowing for certain when they ovulated and timing sex accordingly. I think if you are confident in your charting, it's perfectly reasonable to seek help sooner. We started meeting with an RE about 7 or 8 months into TTC, but that's because I knew from charting that I hadn't ovulated one single time in that period, nor for a considerable period before that, so waiting didn't make a lot of sense. (Sidenote: We did actually get pregnant without medical intervention once I started ovulating on my own again, so obviously my situation is different!)

But at the end of the day, the feeling that something is off is definitely worth heeding. Good luck with getting your labs done - hopefully you will find some answers!

[Sourire]

I think the one year deadline is really so that RE's can avoid getting patients who don't understand their cycle and the only reason they haven't gotten pregnant is because they've been BDing around CD 14 when actually their ovulation is around CD 19! In my opinion if you have 6 cycles of really great BD timing and you're not pregnant, go get some tests done. None of the tests can hurt, and if you find some really obvious problem you'll be so happy you did them. I've heard lots of stories of people getting pregnant really fast, miscarrying, and then trying for years with nothing happening. Waiting longer to see a doctor will only make everything harder and more frustrating, while if you are getting tested and trying some treatments, you feel like you are doing something and moving forward so it's easier to go through.

[SKJ2011]

I agree with the PPs. I'm actually in a very similar place to you (and also in Chitown!). We have been having trouble TTC #2. Took 8 months of well timed intercourse to get pg and had a m/c. I'm now on cycle 3 of trying post-m/c and I just had my first appt with an RE. I posted a similar question to yours, but I was asking b/t OB and RE. Overwhelmingly, people recommended going straight to an RE, so that's what I did. For me, insurance does cover IF, but I needed to have been trying for a year. I just had my first set of b/w and a saline u/s over the past two weeks. I'm waiting to hear what the doc has to say. I can give you more info on where I'm going and what I think of them if you want. Feel free to PM me.

Good luck with your decision. I'm sorry you are dealing with this

[Vegan Princess]

Often insurance will cover infertility TESTING but not the actual treatment. So you could likely go to an RE and at least have all the tests covered. I wouldn't wait any longer.

Good luck!

Cindy

[LLQ1011]

Did yo have a d&c with your mc? Sometimes that causes scar tissue that can block your tubes.

Also an infection is possible. Im sure a fertility specialist will listen to your concerns and do the proper testing. But usually you have to try for a year.

Um why does the doctor need to know you stopped trying for three months??? :P

[thecoffeebean]

Hey Daurelia, I remember that we both lost our babies at the same time in our DDC last July. I don't have any advice for you, but as you can see from my signature I have had a rough year also. No baby on the horizon for me at this time, although we at least have a plan to go forward. Okay, just wanted to say hi and let you know that I'm thinking of you!

[daurelia]

Thank you coffeebean... I remember you too. I am so, so sorry you have had such a rough year. Wow. Thinking of you.  LLQ, I did not have a D&C, but I did take cytotec which caused really intense bleeding... so I've always wondered... SKJ, I'll send you a message! Thank you so much.

Dora

[daurelia]

Thank you so much Sourire. That is a really nice comment and I'm hoping that getting tests done will make me feel like I'm "doing" something. I am again going to be out of town for my day 3 so again no bloodtests yet.   I hate feeling like I have to wait so long to even get basic information, but so it goes. I appreciate the advice from everyone here.

In the meantime, I've decided that I'm going to start psychotherapy. I have been really feeling horrible lately, I cry over nothing... fear that I am infertile is just wreaking havoc on my mental health and I've decided to do something about it.

[dakipode]

Hey daurelia,

I think it's good to take charge and see a therapist, we all need help with staying sane and the TTC process is such an emotional roller coaster (it is for me at least). I recently saw a headline about a study done in Belgium that women who ended up childless because of infertility also had a higher rate of alcoholism and mental health issues... Correlation is not causation but still, interesting...

I just wanted to chime in here because I've decided to "investigate" myself. Who knows, by the time I actually get to see a specialist I could be pregnant, which would be a great problem to have, but the way things are going right now I'm losing faith and I needed to start this process to help with my own mental health.

I'll be curious to follow your journey and I wish you all the best.

[daurelia]

That study does not surprise me at all. I am generally a happy and stable person, but the last year of my life has opened up a whole new box of dark, dark feelings I'd never before experienced. My husband and I have been together for 7 years, and we've always assumed we'd have a baby... and here we are, 1 year after deciding we were ready, and still nothing. I'm so frightened.  I also am feeling all this guilt about my husband, who has wanted children his whole life and ADORES kids, if this is something I prevent him from having I will just hate myself so much. See what I mean? These are all very crazy thoughts I am having. Every time I get my period it's this horrible breakdown and I am sick of it.

And none of my friends understand. Either my friends are not at the babymaking part of their lives yet, so they don't get it, OR, they simply got pregnant right away. So it's hard to talk to people about it, which is why I need to turn to a professional, I think. 

Dakipode, thanks for this sweet comment and I am so glad that you are going to get things checked out just to help make you feel like you are doing something to aid the process.

Thinking of you all!

[AdinaL]

Originally Posted by Vegan Princess 

Often insurance will cover infertility TESTING but not the actual treatment. So you could likely go to an RE and at least have all the tests covered. I wouldn't wait any longer.

Good luck!

Cindy

It really depends on the insurance.  Mine wouldn't cover anything that was primarily used for infertility testing/diagnosis.  They would only cover tests that normal fertile women would also get.  So I paid out of pocket for everything beyond routine blood tests and one cycle of monitoring.  Everything else HSG, Clomid, u/s and on and on was out of pocket.  In fact, my insurance would cover the guy I saw if I saw him at one location where he did primarily OB/GYN, but wouldn't cover him at his other location where he did the bulk of his RE work. 

So, it pays to really check before you jump in with an RE or you could be forking over a LOT of money in the end.  

[AdinaL]

Originally Posted by daurelia 

Thank you so much Sourire. That is a really nice comment and I'm hoping that getting tests done will make me feel like I'm "doing" something. I am again going to be out of town for my day 3 so again no bloodtests yet.   I hate feeling like I have to wait so long to even get basic information, but so it goes. I appreciate the advice from everyone here.

In the meantime, I've decided that I'm going to start psychotherapy. I have been really feeling horrible lately, I cry over nothing... fear that I am infertile is just wreaking havoc on my mental health and I've decided to do something about it.

 Testing really can make you feel like at least you are doing something proactive, which can help a lot. 

Therapy could be really good.  I think often the mental impact is grossly overlooked.  It is a hard path.  I spent a lot of years crying and freaking out and being angry at the world.  (In fact you can search this board and find a few of my really good rants. LOL)  So, taking care of yourself will make a huge difference in your treatment and in your life. There were time when I am surprised my husband stayed married to me. 

[Sourire]

Psychotherapy is a great idea! I myself have been going to see a psychologist on a weekly basis for almost a year and it has helped me so much. Just make sure to find a therapist who specialized in infertility. Not all therapists are created equal, and those who don't know much about infertility may not take it seriously. The first therapist I tried was a guy who didn't have much experience and clearly had no understanding of what I was going through. After 3-4 sessions I quit going and found a woman who specialises in infertility patients... she has made a world of difference in my life. I used to feel like a zombie just going through the motions of life until I could get my BFP and having very frequent emotional breakdowns, now I feel like I can actually enjoy my life again while going through all this!

[AwaitngBabyDust]

Hi Daurelia

I don't exactly call myself a "veteran" however, I have been around the block quite a few times now and do empathize with what you're going through. Its definitely   a downer when you feel like you're doing everything possible to become pregnant and yet nothing happens. and of course, you feel worst when someone you know becomes pregnant who wasnt even trying! hang in there girl!

it does sound as if this is stressing you out, so seeking out a therapist I think is a good idea. I agree w the pp that a therapist who specializes in infertility might prove more useful. also helpful is surrounding yourself around supportive and positive people. hubby and i decided to only tell a few ppl about infertility tx so I did feel very alone, so i actively surrounded myself w positive peeps. who wants to feel drained by negative ppl anyway? u can do w/o the stress.

from what i have read and heard, the rec to see a RE is after 1 year of trying to conceive w unprotected sex. I know you are short of 1 yr since u started a new job, but if you dont have restrictions w your insurance and your hubby is in agreement, get a referral from the gyno and see the RE. if you r not sure, then maybe see the therapist who should help you figure out what you really want to do. Keep in mind, if you see a RE, he/she will most likely send you and hubby for lots of blood tests and other tests to chk your reproductive status. 

I wanna highlight AdinaL's comment re insurance which is really important. def call your insurance carrier to see what infertility coverage u have, otherwise, you will come out w an even heftier bill. there r many things to consider: office visits, lab work, ultrasounds, medications, co-pays, deductibles...i wrote a page about finances on my planningiui blog in case u want to read. it seems very daunting all this legwork, but i am a firm believer, the more knowledge u have, the better off u will be. 

whatever u wind up doing, remember to stay positive. research and ask questions. your hubby will love you no matter what and u r not alone!!! best of luck and lots of positive energy for you.